MEDICARE: LAURA ANN GRIFFITH BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	28194625A	IN

General Provider Information

NPI Number	:	1255214318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN GRIFFITH BSN

Provider Business Mailing Address
First Line	:	7836 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	647 W 100 N
Second Line	:
City	:	PORTLAND
State	:	IN
Zip	:	47371-8071
Country	:	US
Telephone Number	:	260-766-4544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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